Gastro-Oesophageal Reflux Disease

In South Africa, reflux – like cephalopelvic disproportion – is over diagnosed. The majority of babies posset, and many of those majority spit up very frequently. When does normal spitting up become “gastro-oesophageal reflux disease” (GERD – in the States oesophageal is spelt esophageal) where it needs to be treated with medication and surgery?

Babies spit up because they have small stomachs and because they have a weak or under-developed gastro-oesophogeal sphincter. As long as baby is happy for the majority of the time, has plenty of wet and soiled nappies and is gaining weight, spitting up is a completely natural thing. It becomes a medical problem when the spit-up contains stomach acids, baby doesn’t sleep, the baby is in pain and always inconsolable, arches back and neck, spits up blood, has breathing problems and the baby is not gaining weight at all or losing. Babies who don’t vomit, can also have reflux. When GERD is present without vomiting or spitting, it’s referred to as silent reflux. Symptoms would be as above. GERD is diagnosed using various methods such as blood test, ultrasound, Barium swallow or upper GI test, pH probe or upper GI endoscopy.

As mentioned before, most of the time it is normal – but there are situations that can worsen the issue:

Formula feeding

Babies lying on their backs

Swallowing air (causes distention)

Teething (baby swallows saliva – its unnatural to have a HUGE amount of saliva in the stomach, therefore baby will vomit it up to get rid of it)

Colds and a runny nose (baby swallows mucous – same as above)

Food sensitivity to what mother eats which does follow through into breastmilk

Allergies due to environmental factors or medication

Overabundant milk supply

Rapid let-down (baby swallows lots of air)

What can we do to assist in making this a little easier, before we go the medication or surgery route?

Frequent nursing (small amounts of milk consumed at a time)

Ensure a good latch (which minimizes air swallowing)

Skin to skin contact (this encourages frequent nursing and will calm your baby when it panics from posseting)

Upright nursing and posture for mom

Keeping baby upright for at least half an hour after a feed

Baby can also sleep on its stomach during the day if it is going to be SUPERVISED the whole time, this will also sooth the stomach

Put baby in a baby carrier or a sling but not in a car chair – this makes the problem worse because it compresses the digestive tract

Encourage comfort suckling (at the breast)

Eliminate tobacco and caffeine from your diet

Consider mother to child allergies (cows milk, wheat etc.)

Do not thicken feeds with porridge. Baby is not ready for solids anytime before 6 months. This is not as harmless as it seems and studies are showing that doing this is causing lung complications in some children. It works in a sense that there is less spitting up, but the baby still has reflux on the inside (silent reflux). This can also increase the chance of perforating the oesophagus.

If your child is truly diagnosed with GERD (in SA, Doctors will just call it reflux – but it needs to be medicated when it is true GERD) there are ways to treat it, there are the following medical options:

Antacids (Telement Drops)

H2 Blockers & PPI (Zantac & Losec)

Prokinetics (Maxallon)

Cytoprotective Agents (Alsanice & Gaviscon)

There are also several natural treatments that have had much success (please consult a chiropractor, homoeopath or naturopathic doctor before using these remedies):

Chiropractic treatment

Siberian Pine Nut Oil

Probiotics

Homoeopathic remedy NatPhos 6X (both mother and baby can take)

Slippery Elm

Surgery is the last possible step – they will perform a procedure called “Floppy Nissen Fundoplication”. In some hospitals they are now doing this via laparoscopy but this does not reduce the risk that your child will need to go under general anaesthetic and it is major surgery. Please get a second opinion before your child is operated on. There is no cure for GERD. Medication and surgery only serve to hopefully ease the pain and symptoms. Most of all trust your instincts.

In conclusion, is spitting up bad? No, God created babies this way. The majority of the time, it’s just a laundry problem!